Monday, May 15, 2017

Patients With Mental Illness, Diabetes Benefit From Self-Management Program

Patients with mental illness and comorbid diabetes who participated in a targeted illness management program experienced greater improvement in depression, global psychopathology, and functioning compared with those who received treatment as usual, according to a study published today in Psychiatric Services in Advance. The program—known as targeted training in illness management (TTIM)—blends psychoeducation, behavioral modeling, problem identification, and goal setting.

“Despite recent attention to the benefits of integrating mental and general medical services among people with serious mental illness, progress has been hampered by a variety of barriers,” Martha Sajatovic, M.D., a professor of psychiatry at Case Western Reserve University School of Medicine, and colleagues wrote. Incorporating TTIM into therapy may overcome some barriers through “a ‘bottom-up’ approach that taps into a traditionally underused resource—the power of an individual to promote his or her health,” they continued.

The researchers randomly assigned 200 people with diabetes and serious mental illness (including schizophrenia, bipolar disorder, or major depressive disorder) to receive TTIM or usual care. TTIM consisted of 12 weekly group, in-person sessions led by a nurse educator and peer educator with serious mental illness and diabetes. After 12 weeks, the patients participated in weekly check-ins by phone with the nurse and peer educators for 48 weeks. Patients in the usual care group received care through their primary care provider, as needed.

Psychiatric symptom severity, functioning, general health, and diabetes control were assessed at the beginning of the trial and again at 13, 30, and 60 weeks.

Patients who received TTIM showed significantly greater improvements in psychiatric symptoms (measured by the Clinical Global Impression scale and Montgomery-Åsberg Depression Rating Scale) over the 60-week period compared with patients who received treatment as usual. Patients in TTIM group also showed greater functioning (measured by the Global Assessment of Functioning scale), diabetes knowledge, and long-term glycemic control compared with the patients who received usual treatment.

“A targeted self-management approach that taps into the power of patients to help themselves and that addresses psychiatric illness and diabetes concurrently improved mental health symptoms and functioning and may have been protective against loss of diabetes control among patients with reasonable diabetes control at baseline,” the authors concluded. “The TTIM approach deserves further study given the extensive personal and financial burden of comorbidity in serious mental illness.”

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